Your kids are almost launched, your periods are slowing down, and you are finally planning some bucket list trips. So why is your leaky bladder worse than ever? Welcome to one of the common early menopause symptoms: incontinence.
First of all, you are not alone. Although menopause doesn’t cause urinary incontinence, it can contribute to and worsen incontinence as women’s bodies age. Worldwide, 1 in 3 women experiences some form of incontinence. According to the National Poll on Healthy Aging, almost half of US women age 50 and older experience urinary incontinence, a figure that increases for women over 65.
Menopause doesn’t have a playbook. There’s a range of menopause symptoms and onset ages (the average US age is 51), but each woman’s journey is different. Here are the basics about incontinence during menopause and how to fix it
What are Some Early Menopause Symptoms?
Menopause is the time in a woman’s life after she has stopped menstruating for 12 consecutive months. Early menopause refers to women who enter menopause younger than age 45, while premature menopause describes women under age 40. When we think of menopause symptoms, we’re usually identifying issues that actually begin earlier with perimenopause.
What is Perimenopause?
Perimenopause is the span of transition between regular menstruation and the absence of a period for 12 months. During this time, a woman’s body decreases estrogen and progesterone production, possibly resulting in hot flashes, night sweats, and/or irregular periods. Some of the lesser-known early menopause symptoms include development of stress or urge incontinence during perimenopause.
What are Some Perimenopause and Menopause Symptoms?
- Irregular periods. One of the early signs of menopause is less predictable periods. Menstrual flow can be lighter or heavier, plus the frequency may vary. Women might go months without experiencing a period thinking they’ve achieved menopause, only for menstruation to begin again. Conversely, periods might be more frequent.
- Hot flashes. Approximately 75% of women experience sudden bouts of intense heat known as hot flashes. There is no known cause for hot flashes, but certain things might trigger or worsen them, such as alcohol, caffeine, stress, and smoking.
- Night sweats. Some women experience hot flashes at night while sleeping. These hot flashes are usually accompanied by sweats that awaken many women, leading to exhaustion and irritability.
- Sleep issues. As mentioned, night sweats can interfere with sleep. However, hormonal fluctuations without night sweats can also contribute to a lack of sleep and irregular sleep patterns. Clinicians can test for hormone levels to determine a course of treatment to help regulate sleep.
- Weight gain. As women age, estrogen production decreases, which may lead to increased appetite and less desire to exercise. A lack of estrogen also means a slowing metabolism, as the body becomes less efficient in converting energy. These changes mean aging women are burning fewer calories and have increased hunger cravings.
- Pelvic floor health. Vaginal dryness and incontinence are two common complaints during menopause. Painful sexual intercourse may indicate a change in vaginal lubrication, which can be treated with an over-the-counter personal lubricant. Urinary incontinence can develop when the pelvic floor muscles are out of shape or stretched from childbirth. Kegels and other treatments can tone these muscles and help support the bladder to reduce leaks.
How do perimenopause and menopause affect incontinence?
When a woman is heading toward menopause, her body produces fewer hormones. With declining hormone production, a woman’s overall muscle tone and elasticity decreases. This also means pelvic floor muscles weaken, and the urethra lining thins, providing less support for bladder control.
These changes often result in stress urinary incontinence, which leads to bladder leaks when a woman sneezes, coughs, or puts sudden pressure on the pelvic floor muscles. And according to the North American Menopause Society, up to 25% of women with incontinence experience leakage during sexual intercourse. With weight gain, your pelvic floor has to work harder to support your bladder, which often leads to incontinence. Obesity is a strong risk factor for incontinence.
Urge urinary incontinence comes in the form of sudden urges to urinate, resulting in leakage. This condition is related to how the nervous system signals the muscles controlling the bladder. These muscles may be overstimulated, producing stronger contractions than normal.
Nocturia refers to getting up to pee one or more times per night. This condition could be due to the production of more urine than normal. According to the Sleep Foundation, we produce less of an anti-diuretic hormone as we age, so more urine is produced resulting in more trips to the bathroom. Another potential cause is the weakening of the bladder and pelvic structures so they aren’t able to hold a normal amount of urine.
Not only are these conditions a nuisance, but they can also impact a woman’s lifestyle. Embarrassing leaks may prevent women from traveling, going out to social events, or engaging in sexual activity. There’s also a significant cost to incontinence incurred by purchasing pads and absorbent undergarments. Women affected by nocturia often report sleep deprivation, which can result in moodiness, increased risk of falls, and general fatigue.
How can I fix incontinence during menopause?
Even though it’s unclear if menopause actually causes incontinence, menopause can contribute to bladder leaks. The good news is there are some proven solutions for incontinence. Lifestyle choices such as losing weight and eating well for incontinence are always helpful.
- Stress incontinence solutions come in all shapes and sizes, with a single goal of strengthening pelvic floor muscles.
- Kegel exercises. Repetitive contractions of the pelvic floor muscles help improve incontinence by strengthening the muscles that control bladder flow.
- Vaginal stimulation devices. Vaginal probes are inserted internally to stimulate pelvic floor muscle contractions.
- Elitone. This external device gently stimulates pelvic floor muscle contractions with no internal probe. This essentially does the exercises longer and stronger than you could on your own, to improve incontinence.
- Urge incontinence treatments include medications to relax overactive bladder muscles. Topical estrogen cream also can be used to invigorate vaginal and urethra tissues so they resume restricting urine flow.
- Nocturia treatments range from controlling liquid intake to doctor-prescribed medication, depending on the cause of nocturia. Surgical solutions and pelvic floor muscle strengthening may be recommended if there is a structural problem.
Going through the range of early menopause symptoms can be a challenge, especially when it comes to maintaining an active lifestyle while grappling with bladder issues. Although there’s no easy answer to why some women experience increased urinary incontinence during menopause, the available solutions ensure that women can continue to lead dynamic lives throughout perimenopause and menopause without pesky leaks. Strengthening your pelvic floor now will reduce the risk of needing to buy adult diapers later.